Expanded HIV Testing and Linkage to Care: Conventional vs. Point-of-Care Testing and Assignment of Patient Notification and Linkage to Care to an HIV Care Program

The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC) testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US.

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Same-Day CD4 Testing to Improve Uptake of HIV Care and Treatment in South Africa: Point-of-Care Is Not Enough

AIDS Research and Treatment ◽

10.1155/2013/941493 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Bruce A. Larson ◽

Kathryn Schnippel ◽

Alana Brennan ◽

Lawrence Long ◽

Thembi Xulu ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Point Of Care ◽

Linkage To Care ◽

Retention In Care ◽

Baseline Period ◽

Hiv Care ◽

Hiv Positive ◽

Care And Treatment ◽

Cd4 Testing

Background. We evaluated whether a pilot program providing point-of-care (POC), but not rapid, CD4 testing (BD FACSCount) immediately after testing HIV-positive improved retention in care.Methods. We conducted a retrospective record review at the Themba Lethu Clinic in Johannesburg, South Africa. We compared all walk-in patients testing HIV-positive during February, July 2010 (pilot POC period) to patients testing positive during January 2008–February 2009 (baseline period). The outcome for those with a≤250cells/mm3when testing HIV-positive was initiating ART<16weeks after HIV testing.Results. 771 patients had CD4 results from the day of HIV testing (421 pilots, 350 baselines). ART initiation within 16 weeks was 49% in the pilot period and 46% in the baseline period. While all 421 patients during the pilot period should have been offered the POC test, patient records indicate that only 73% of them were actually offered it, and among these patients only 63% accepted the offer.Conclusions. Offering CD4 testing using a point-of-care, but not rapid, technology and without other health system changes had minor impacts on the uptake of HIV care and treatment. Point-of-care technologies alone may not be enough to improve linkage to care and treatment after HIV testing.

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Digitising point of care HIV test results to accurately measure, and improve performance towards, the UNAIDS 90-90-90 targets

10.1101/19012302 ◽

2019 ◽

Author(s):

Nisha Jacob ◽

Brian Rice ◽

Emma Kalk ◽

Alexa Heekes ◽

Jennie Morgan ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Point Of Care ◽

Linkage To Care ◽

Hiv Care ◽

Western Cape ◽

Newly Diagnosed ◽

Cross Sectional ◽

Hiv Test ◽

Testing Data

AbstractIntroductionHigh rates of pre-treatment loss to care among persons diagnosed with HIV persist. Linkage to care can be improved through active digitally-based surveillance. Currently, record-keeping for HIV diagnoses in South Africa is paper-based. Aggregated testing data are reported routinely, and only discordant findings result in a specimen being tested at a laboratory and digitised.MethodsThe Western Cape Province in South Africa has a Provincial Health Data Centre (PHDC) where person-level routine data are consolidated in a single database, leveraging the existence of a unique patient identifier. To facilitate improved surveillance, a pre-carbonated point-of-care test (PoCT) form was piloted, where one copy was routed to the centralised laboratory and digitised for PHDC inclusion. We evaluated the utility of the intervention using cross-sectional and retrospective cohort analyses, as well as comparisons with reported aggregate data.ResultsFrom May 2017 to June 2018, 11337 digitised point-of-care HIV testing records were linked to the PHDC. Overall, 96% of records in the aggregate dataset were digitised, with 97% linked to the PHDC. Of those tested, 79% were female (median age 27 years). Linkage demonstrated that 51.3% of patients testing HIV-positive were retesting. Of those truly newly diagnosed, 81% were linked to HIV care and 25% were initiated on antiretroviral therapy immediately.ConclusionDigitisation of PoCT results is feasible and provides individuated HIV testing data to assist in linkage to care and in differentiating newly diagnosed patients from positive patients retesting. Actionable and accurate data can improve the measurement of performance towards the UNAIDS 90-90-90 targets.

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Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053195 ◽

2017 ◽

Vol 94 (3) ◽

pp. 194-199 ◽

Cited By ~ 4

Author(s):

James Blain Johnston ◽

Joss N Reimer ◽

John L Wylie ◽

Jared Bullard

Keyword(s):

Viral Load ◽

Hiv Testing ◽

Clinical Outcomes ◽

Point Of Care ◽

Age Groups ◽

Linkage To Care ◽

Hiv Positive ◽

Hiv Status ◽

Viral Load Suppression ◽

Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

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Rapid Point-of-Care CD4 Testing at Mobile HIV Testing Sites to Increase Linkage to Care

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e31825eec60 ◽

2012 ◽

Vol 61 (2) ◽

pp. e13-e17 ◽

Cited By ~ 73

Author(s):

Bruce A. Larson ◽

Kathryn Schnippel ◽

Buyiswa Ndibongo ◽

Thembisile Xulu ◽

Alana Brennan ◽

...

Keyword(s):

Hiv Testing ◽

Point Of Care ◽

Linkage To Care ◽

Cd4 Testing

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Venues and methods to improve professional men’s access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study

BMC Health Services Research ◽

10.1186/s12913-021-07259-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Patience A. Muwanguzi ◽

Esther M. Nasuuna ◽

Florence Namimbi ◽

Charles Peter Osingada ◽

Tom Denis Ngabirano

Keyword(s):

Qualitative Study ◽

Hiv Testing ◽

Underserved Populations ◽

Linkage To Care ◽

Sub Saharan Africa ◽

Hiv Care ◽

Eligibility Criteria ◽

Prevention Services ◽

Self Testing ◽

Engaging Men

Abstract Background HIV testing among men in sub-Saharan Africa is sub-optimal. Despite several strategies to improve access to underserved populations, evidence regarding engaging men in professional and formal occupations in HIV testing is limited. This study explored employed professional men’s preferences for uptake of HIV self-testing, and linkage to HIV care, or prevention services. Methods This was an explorative-descriptive qualitative study where a sample of 33 men from six Ugandan urban centres. Participants were purposively selected guided by the International Standard Classification of Occupations to participate in in-depth interviews. The data were collected using an interview guide and the sample size was determined by data saturation. Eligibility criteria included fulltime formal employment for over a year at that organization. The data were analyzed manually using thematic content analysis. Results Three categories emerged: uptake of HIV self-tests, process of HIV self-testing and linkage to post-test services. The different modes of distribution of HIV self-test kits included secondary distribution, self-tests at typically male dominated spaces, delivery to workplaces and technology-based delivery. The process of HIV self-testing may be optimized by providing collection bins, and mHealth or mobile phone applications. Linkage to further care or prevention services may be enhanced using medical insurance providers, giving incentives and tele counselling. Conclusion We recommend utilization of several channels for the uptake of HIV self-tests. These include distribution of test kits both to offices and men’s leisure and recreation ‘hot spots’, Additionally, female partners, peers and established men’s group including social media groups can play a role in improving the uptake of HIV self-testing. Mobile phones and digital technology can be applied in innovative ways for the return of test results and to strengthen linkage to care or prevention services. Partnership with medical insurers may be critical in engaging men in professional employment in HIV services.

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Cost-effectiveness of point-of-care testing with task-shifting for HIV care in South Africa: a modelling study

The Lancet HIV ◽

10.1016/s2352-3018(20)30279-4 ◽

2020 ◽

Author(s):

Monisha Sharma ◽

Edinah Mudimu ◽

Kate Simeon ◽

Anna Bershteyn ◽

Jienchi Dorward ◽

...

Keyword(s):

South Africa ◽

Cost Effectiveness ◽

Point Of Care ◽

Task Shifting ◽

Hiv Care ◽

Point Of Care Testing ◽

Modelling Study

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Cost-Effectiveness of Point-of-Care Testing with Task-Shifting for HIV Care in South Africa: A Modelling Study

SSRN Electronic Journal ◽

10.2139/ssrn.3571531 ◽

2020 ◽

Author(s):

Monisha Sharma ◽

Edinah Mudimu ◽

Kate Simeon ◽

Anna Bershteyn ◽

Jienchi Dorward ◽

...

Keyword(s):

South Africa ◽

Cost Effectiveness ◽

Point Of Care ◽

Task Shifting ◽

Hiv Care ◽

Point Of Care Testing ◽

Modelling Study

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Pharmacist Testers in Multidisciplinary Health care Team Expand HIV Point-of-Care Testing Program

Journal of Pharmacy Practice ◽

10.1177/0897190013514090 ◽

2013 ◽

Vol 27 (6) ◽

pp. 578-581 ◽

Cited By ~ 5

Author(s):

Elizabeth M. Sherman ◽

Shara Elrod ◽

Deberenia Allen ◽

Paula Eckardt

Keyword(s):

Health Care ◽

Hiv Testing ◽

Health Care Providers ◽

Point Of Care ◽

Health Care Team ◽

Care Providers ◽

Point Of Care Testing ◽

Testing Program ◽

Public Health Challenges ◽

Hiv Serostatus

Knowledge of HIV serostatus is the first step to accessing treatment, reducing transmission, and mitigating public health challenges. We describe the expansion of an HIV point-of-care testing (POCT) program within a health care system utilizing pharmacists as testers. The testing program’s expansion is detailed and its impact assessed. The POCT program was evaluated by comparing the number of traditional HIV venipuncture tests to the number of POCTs performed across the health system as well as comparing the number of POCTs performed by clinical pharmacists to the number of tests at other POCT locations. Although pharmacists’ contributions to HIV prevention are well documented, pharmacists’ involvement in HIV testing initiatives is still nascent. Our POCT program demonstrates an effective HIV testing initiative driven by pharmacists and other health care providers.

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